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See also orthodontics
What is orthognathic surgery?
Orthognathic surgery is a specialist branch of oral and maxillofacial
surgery and is usually part of orthodontic treatment. It involves
the modification of the jaws in order to change their alignment
and position to improve both the function and appearance of the
mouth and sometimes airway (how you breathe).
For the best results, orthodontics and orthognathic surgery should
be planned together. Choosing this type of treatment requires
a considerable commitment from you because the alteration of the
positions of both your jaw and teeth is not a speedy process.
What does orthognathic surgery involve?
Your orthodontists and maxillofacial surgeons will explain the
details of what you should expect because this will depend on
the actual surgery being performed.
This type of surgery is carried out while you are asleep under
a general anaesthetic. Usually, you will be admitted to the ward
the day before the operation.
Before the surgery, you will require a period during which you
will need to wear fixed appliances/braces.
What do you do during the orthognathic surgery operation?
The details of the surgery performed will depend on what you
are having done and will be explained to you by your oral and
maxillofacial surgeon.
Surgery might aim to reposition part or all of the top and/or
lower jaw(s).
The surgeon (usually) gains access to the bones inside the mouth
via the gums. Once the areas of bone have been revealed and loosened
they are moved into a new position and fixed in position with
small metal plates and screws, which usually remain in the bone.
Sometimes these plates will be removed later, which will mean
another operation. The jaw position is also maintained using a
thin, clear plastic splint (or wafer), which sometimes remains
secured to the lower teeth for some weeks. We use dissolving stitches
to neatly close up the gums.
Will I have scars after the orthognathic surgery?
The majority of orthognathic surgery is performed within the
mouth so the only scars will be tiny white lines along your gum
line.
What will I feel like after the orthognathic surgery?
When you wake up from your anaesthetic, you will feel sleepy,
swollen and sore around the mouth and face.
During the surgery, we take great care to protect the nerves
that run through the jaws, however, immediately after your surgery
some areas of your face might feel numb. This usually recovers
with time (see below).
When you first wake up, you will be able to open your mouth.
From the next day, however, some gentle elastic bands are used
with the braces on the upper and lower teeth, to guide your teeth
into position.
For the first few days, your face will be swollen and you might
have some bruising especially under your chin and sometimes on
your neck due to resolving bruising from your jaws.
You should be up and about within a day or two and back to a
normal routine within a month (see below).
When will I see the difference in the appearance of my face?
For the first few days your face will be swollen and you might
have some multicoloured bruising. As the swelling goes down and
the bruising fades, you will start to see the improvement in your
face.
How long will I need to stay in hospital after the orthognathic
surgery?
After the surgery, you might spend three to seven days in hospital.
During this period, you will recover after the operation with
expert supervision by our maxillofacial team.
What will I need to do after I leave hospital?
After surgery, it is very important that you keep your mouth
and braces clean to prevent infection. You will be shown by the
dental hygienist or dental health educator how to do this.
The elastics that hold your teeth in their new alignment will
need to be replaced with fresh ones once the elastic bands lose
their flexibility. We will do this at first and will then show
you how to do it for yourself at home.
Your mouth will feel a bit 'new and fragile' at first and for
the first few months you will only be able to eat small amounts.
The dietitian will advise you on how to prepare liquid and soft
diets that are also nutritious.
A good diet is essential for good healing and recovery. You will
need a blender to prepare easy to eat food.
How long will I need to take off work/study to recover after
orthognathic surgery?
After you have left hospital after orthognathic surgery, you
are advised to arrange a month off work or school/college.
How often will I need to return to the clinic for checkups
after orthognathic surgery?
During the month after your orthognathic surgery, you will be
reviewed weekly so we can monitor and assess your progress. After
this first month, we will see you every three months for six months.
You will also have orthodontic appointments during this time
for adjusting your 'braces'.
How long will it take for my jaws to heal?
The length of time it takes for people to heal depends on how
old and fit they are but in general the jaw bones are almost healed
after two to three months.
Will some areas of my face and mouth feel numb after orthognathic
surgery?
During the surgery, we take great care to protect the nerves
that run through the jaws, however, immediately after your surgery
some areas of your face might feel numb. This usually recovers
with time.
If we have moved your upper jaw, the numb feeling is (usually)
only in the cheeks, upper lip and teeth. If we moved your lower
jaw, you might have some numbness of the lower lip, chin and teeth,
and possibly the tongue.
Why do some people get numbness after orthognathic surgery?
Numbness, which we call paraesthesia, is a reduction in the
sensation of the area served by particular sensory nerves and
their nerve endings.
During surgery, it is relatively easy to protect from direct
damage the (larger) nerves that run through the upper and lower
jaws. These nerves divide in the jaws and tissues into thinner
branches and tiny nerve endings, which can't be easily seen and
protected. Some of them are likely to be cut or bruised during
the surgery, but individual branches will only serve smaller areas
of skin and tissue so the area affected will be limited.
Nerves can repair themselves if they are just bruised and if
the cut ends lie closely can mend on their own. This means that
most numbness after orthognathic surgery will return to normal
over the weeks or months after the operation.
You also have nerves that control the movement of your facial
muscles and jaws. Happily these do not run in the areas of the
face and jaws that are routinely operated on during orthognathic
surgery and so the movement of the face and lips should not be
affected by this surgery.
Might I have long-term numbness after orthognathic surgery?
Very rarely after orthognathic surgery, you will be left with
an area of permanently dulled or altered sensation.
What sort of orthodontics will I need after orthognathic surgery?
Your oral and maxillofacial surgeon and orthodontist will have
worked closely to plan your surgery and the orthodontic treatment
before and afterwards.
Most people require at least some orthodontic treatment after
the surgery to fine-tune the tooth alignment and obtain the best
fit of the upper and lower teeth in the new position of the jaws.
This can take from three to twelve months, after which the fixed
braces are removed.
After fixed appliances are removed, there is usually a period
of settling in of the teeth. During this time, fixed or removable
retainers are used to control unwanted tooth movement. In the
upper jaw a removable retainer is usually used, which can be removed
for cleaning. In the lower jaw, a discreet fixed retainer is usually
glued behind the lower front teeth and can be used for up to 12
months.
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